Serial cervical-length measurements after first episode of threatened preterm labor improve prediction of spontaneous delivery prior to 37 weeks' gestation
G Chiossi, F Facchinetti, P Vergani, M Di Tommaso, L Marozio, B Acaia, L Pignatti, A Locatelli, M Spitaleri, C Benedetto, B Zaina, R D'Amico, PROTECT Collaborative Group, G Chiossi, F Facchinetti, P Vergani, M Di Tommaso, L Marozio, B Acaia, L Pignatti, A Locatelli, M Spitaleri, C Benedetto, B Zaina, R D'Amico, PROTECT Collaborative Group
Abstract
Objective: To assess whether repeat cervical-length (CL) measurement in women discharged from hospital after their first episode of threatened preterm labor can predict their risk of spontaneous preterm birth.
Methods: This was a secondary analysis of a randomized controlled trial of maintenance tocolysis, in which CL was measured on transvaginal ultrasound at the time of hospital discharge and after 2, 4, 8 and 12 weeks, in women who remained undelivered after their first episode of threatened preterm labor. After univariate analysis, multivariate logistic regression analysis was used to assess whether CL < 10 mm at the time of hospital discharge or at any follow-up evaluation could predict spontaneous delivery prior to 37 weeks of gestation.
Results: Of 226 women discharged after a diagnosis of threatened preterm labor, 57 (25.2%) delivered spontaneously prior to 37 weeks' gestation. The risk of spontaneous preterm birth was higher among women with CL < 10 mm at hospital discharge compared to those with CL ≥ 10 mm (adjusted odds ratio (aOR), 3.3; 95% CI, 1.2-9.2). Moreover, spontaneous preterm delivery was more common when CL < 10 mm was detected up to 2 weeks (aOR, 2.9; 95% CI, 1.1-7.3) or up to 4 weeks (aOR, 7.3; 95% CI, 2.3-22.8) post discharge, as compared with when CL was persistently ≥ 10 mm. The association was not significant when considering CL measurements at 8 weeks, and there was insufficient information to assess the effect of measurements obtained at 12 weeks.
Conclusions: Women who remain undelivered after their first episode of threatened preterm labor continue to be at high risk of spontaneous preterm birth if their CL is below 10 mm at the time of hospital discharge or at any follow-up visit up to 4 weeks later. CL measurement could be included in the antenatal care of these women in order to stratify their risk of preterm birth, rationalize resource utilization and help clinicians improve pregnancy outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Keywords: cervical length; spontaneous preterm birth; threatened preterm labor.
© 2020 International Society of Ultrasound in Obstetrics and Gynecology.
References
REFERENCES
- Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S, Lackritz EM, Lee SK, Mason E, Serazin AC, Walani S, Simpson JL, Lawn JE. Born Too Soon preterm prevention analysis group. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 2013; 381: 223-234.
- Kochanek KD, Murphy SL, Xu J, Arias E. Deaths: final data for 2017. Natl Vital Stat Rep 2019; 68: 1-77.
- Simhan HN, Caritis SN. Prevention of preterm delivery. N Engl J Med 2007; 357: 477-487.
- Sotiriadis A, Papatheodorou S, Kavvadias A, Makrydimas G. Transvaginal cervical length measurement for prediction of preterm birth in women with threatened preterm labor: a meta-analysis. Ultrasound Obstet Gynecol 2010; 35: 54-64.
- Berghella V, Palacio M, Ness A, Alfirevic Z, Nicolaides KH, Saccone G. Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 2017; 49: 322-329.
- Facchinetti F, Vergani P, Di Tommaso M, Marozio L, Acaia B, Vicini R, Pignatti L, Locatelli A, Spitaleri M, Benedetto C, Zaina B, D'Amico R. Progestogens for Maintenance Tocolysis in Women With a Short Cervix: A Randomized Controlled Trial. Obstet Gynecol 2017; 130: 64-70.
- [Management of spontaneous preterm birth according to SIGO]. .
- Berghella V, Bega G, Tolosa JE, Berghella M. Ultrasound assessment of the cervix. Clin Obstet Gynecol 2003; 46: 947-962.
- Romero R, Conde-Agudelo A, Da Fonseca E, O'Brien JM, Cetingoz E, Creasy GW, Hassan SS, Nicolaides KH. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. Am J Obstet Gynecol 2018; 218: 161-180.
- Fuchs IB, Henrich W, Osthues K, Dudenhausen JW. Sonographic cervical length in singleton pregnancies with intact membranes presenting with threatened preterm labor. Ultrasound Obstet Gynecol 2004; 24: 554-557.
- Oyelese Y, Powel J, Benito CW. Perhaps cerclage is the ideal treatment for the cervix < 1 cm. Am J Obstet Gynecol 2018; 219: 213.
- Berghella V, Ciardulli A, Rust OA, To M, Otsuki K, Althuisius S, Nicolaides KH, Roman A, Saccone G. Cerclage for sonographic short cervix in singleton gestations without prior spontaneous preterm birth: systematic review and meta-analysis of randomized controlled trials using individual patient-level data. Ultrasound Obstet Gynecol 2017; 50: 569-577.
- Hermans FJR, Bruijn MMC, Vis JY, Wilms FF, Oudijk MA, Porath MM, Scheepers HCJ, Bloemenkamp KWM, Bax CJ, Cornette JMJ, Nij Bijvanck BWA, Franssen MTM, Vandenbussche FPHA, Kok M, Grobman WA, Van Der Post JAM, Bossuyt PMM, Opmeer BC, Mol BWJ, Schuit E, Van Baaren GJ. Risk stratification with cervical length and fetal fibronectin in women with threatened pretermlabor before 34 weeks and not delivering within 7 days. Acta Obstet Gynecol Scand 2015; 94: 715-721.
- Esplin SM, Elovitz MA, Iams JD, Parker CB, Wapner RJ, Grobman WA, Simhan HN, Wing DA, Haas DM, Silver RM, Hoffman MK, Peaceman AM, Caritis SN, Parry S, Wadhwa P, Forout T, Mercer BM, Hunter SM, Saade GR, Reddy UM, nuMoM2b Network. Predictive Accuracy of Serial Transvaginal Cervical Lengths and Quantitative Vaginal Fetal Fibronectin Levels for Spontaneous Preterm Birth Among Nulliparous Women. JAMA 2017; 317: 1047-1056.
- Wagner P, Sonek J, Heidemeyer M, Schmid M, Abele H, Hoopmann M, Kagan KO. Repeat Measurement of Cervical Length in Women with Threatened Preterm Labor. Geburtshilfe Frauenheilkd 2016; 76: 779-784.
- Sotiriadis A, Kavvadias A, Papatheodorou S. Paraskevaidis E, Makrydimas G.The value of serial cervical length measurements for the prediction of threatened preterm labour. Eur J Obstet Gynecol Reprod Biol 2010; 148: 17-20.
- Rozenberg P, Rudant J, Chevret S. Boulogne AI, Ville Y.Repeat measurement of cervical length after successful tocolysis. Obstet Gynecol 2004; 104: 995-999.
- Hiersch L, Yogev Y, Domniz N, Meizner I, Bardin R, Melamed N. The role of cervical length in women with threatened preterm labor: is it a valid predictor at any gestational age? Am J Obstet Gynecol 2014; 211: 532.e1-9.
- Amabebe E, Reynolds S, He X, Wood R, Stern V, Anumba DOC. Infection/inflammation-associated preterm delivery within 14 days of presentation with symptoms of preterm labour: A multivariate predictive model. PLoS One 2019; 14: e0222455.
Source: PubMed